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ORIGINAL ARTICLE
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Assessment of health-promoting lifestyle profile in undergraduate medical students of a medical college


1 Department of Community Medicine, Government Medical College, Baramati, Maharashtra, India
2 Department of Community Medicine, B. J. Government Medical College, Baramati, Maharashtra, India
3 THO, Saoner, Zilha Parishad, Pune, Maharashtra, India
4 BTO, Civil Hospital, Ahmednagar, Maharashtra, India
5 THO, Baramati, Maharashtra, India
6 Department of Community Medicine, Indira Gandhi Government Medical College, Nagpur, Maharashtra, India

Date of Submission05-Feb-2021
Date of Decision11-Apr-2021
Date of Acceptance11-Apr-2021

Correspondence Address:
Malangori Abdulgani Parande,
Department of Community Medicine, B. J. Government Medical College, Pune - 411 001, Maharashtra
India
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/mjdrdypu.mjdrdypu_93_21

  Abstract 


Introduction: According to the available statistics, 53% of deaths are related to lifestyle. The aim of this study was to evaluate health-promoting lifestyles in medical students of a medical college of Western Maharashtra, India. Objectives: To determine the health-promoting lifestyle behaviours among undergraduate medical students and to find out sociodemographic determinants of HPLP. Material and Methods: This cross-sectional study was performed on 307 undergraduate medical students. Health Promotion Lifestyle Profile Proforma (HPLP)was prepared which consists of two parts, Part I deals with the sociodemographic characteristics of the participants and Part II of the proforma deals with Health-promoting lifestyle information which was a modified version of HPLP II. It consists of 46 items divided into 7 subscales. Permission of Institute Ethical Committee was taken. Data was analyzed by using analysis of variance (ANOVA) and Mann Whitney test and predictors were determined by multiple linear regression analysis. Results: Medical students of this Institute showed good level of health-promoting lifestyle in total HPLP II score. The overall HPLP-II mean score and all subscales of HPLP except interpersonal relations were significantly more among the first and third year students than 2nd year students. Female students practiced significantly better food practices while Male students showed a significantly higher level of physical activity and self-concept. Income was the significant predictor of overall HPLP; age was the significant predictor of Health responsibility, sex and income were the significant predictor of physical activity, sex, living with family and income were significant predictor for food practices; sex, living with family were predictors of spiritual growth; BMI and income as a predictors for Interpersonal relations; and age was a predictor for stress management. Conclusion: The study results showed that Medical college students in Pune had reasonably good orientation towards health promoting practices.

Keywords: Health behavior, health promotion, level of education, lifestyle, medical students, undergraduate



How to cite this URL:
Tapare VS, Borle P S, Parande MA, Sakore D, Ingole S, Salunke J, Gajbhiye S. Assessment of health-promoting lifestyle profile in undergraduate medical students of a medical college. Med J DY Patil Vidyapeeth [Epub ahead of print] [cited 2021 Dec 6]. Available from: https://www.mjdrdypv.org/preprintarticle.asp?id=327557




  Introduction Top


Health is a basic human right. Health promotion is “the process of enabling people to increase control over and to improve health.”[1] It is not directed against any particular disease but is intended to strengthen the host through a variety of approaches such as health education, nutritional interventions, lifestyle, and behavioral changes, etc., Health-promoting lifestyle is an important determinant of the health status of a person. As per the WHO, India is one of the countries where the burden of lifestyle diseases will be more in near future and it will be seen one or two decades earlier.[2],[3]

Today's medical student is tomorrow's treating doctor. Medical students are specifically expected to play a key role in health promotion in their near future as physicians. The adoption and practice of a healthy lifestyle by medical students are critical for them to be role models and have the ability to influence their patients and the general population. Studying medicine can pose a threat to students' health and well-being. A perceived highly competitive environment, the challenges imposed by confrontations with disease, suffering, and death, a high workload, and a lack of social support are among the factors that contribute to a declining general and mental health during medical education. Apart from personal suffering, physicians' impaired health and well-being may have a negative impact on the quality and availability of health services.[4],[5]

Facing the increasing needs of the patients, whether these medical students can develop health-promoting lifestyles from their studying time and thus function within wellness role models expectation of the patients is the main concern of this study. However, there is a paucity of research studies investigating the health-promoting lifestyles of medical students in India. Therefore, the aim of this study was to determine and evaluate the health-promoting lifestyle behaviors among medical students as well as examine any sociodemographic determinants. The results of this study will help university administrators and medical curriculum planners in designing, targeting, and implementing health-promoting programs to increase awareness in this population.


  Materials and Methods Top


A descriptive cross-sectional study was conducted among the undergraduate medical students of B.J. Government Medical College and Sassoon General Hospitals, Pune. The study was conducted from August 1, 2018 to August 31, 2018. The students who were present at the time of study and willing to participate were included in the study.

Study assessment

Health Promotion Lifestyle Profile (HPLP) Proforma was prepared which consists of two parts, Part I deals with the sociodemographic characteristics of the participants (age, sex, year of study, place of residence, family's monthly income, marital status, height, and weight) and any history of chronic illness, history of addiction, etc., and Part II of the proforma deals with Health-promoting lifestyle information. This Health-promoting lifestyle information was a modified version of HPLP II developed by Walker, Sechrist, and Pender.[6] This modified proforma consists of 46 items divided into 7 subscales (Health responsibility-7 items, Physical activity-7 items, Food practices-10 items, Spiritual growth-5 items, Self-concept-6 items, Interpersonal relations-6 items, and Stress management-5 items). The scale measures health-promoting behaviors on a 3 point Likert scale; never, sometimes, and routinely. A score for overall health-promoting behaviors is obtained by calculating the mean of the individual's responses to all 46 items. Each item was scored by a fixed 3-point Likert-type format where: “never” was coded as 0, “sometimes” as 1, and “routinely” as 2. The term “routinely” was chosen to represent the most frequent response category because it suggested a regular pattern of behaviors or characteristics of lifestyle. To calculate a mean score for each subscale, the scores of those particular items were summed up and then divided by the numbers of respondents. Higher mean scores denoted positive health-promoting lifestyle or behaviors. The overall HPLP score ranged from 0 to 92. The score was categorized as poor when the HPLP Score was below 23, as average when the score was between 24 and 46, as good when the score ranged between 47 and 69 and excellent when it was between 70 and 92. A pilot study was conducted to see the reliability of the questionnaire and the Cronbach's alpha coefficient was 0.8197. The validity of the pro forma was obtained by a team of seven experts and modified as per the corrections suggested.

Study conduct

A predesigned and a pretested questionnaire was used to collect data. The questionnaire was distributed to all medical students who were present in the classroom. The principal investigator and co-investigators explained the pro forma to all students.

Ethical considerations

Permission of the Institute Ethical Committee was taken. Permission from the Dean of the medical college was also taken. Informed consent from all students was taken. They had been informed that participation was voluntary and assured about the confidentiality of the information.

Data analysis

The data were tabulated and analyzed using MS Excel. A composite score for HPLP was obtained as well as individual subscales scores. Descriptive statistics were used to describe socio-demographics characteristics and HPLP. Data were analyzed by using analysis of variance and Mann–Whitney test and predictors were determined by multiple linear regression analysis. Findings were considered statistically significant if the P ≤ 0.05.


  Results Top


This survey was completed by 307 students out of 348 (response rate was 88.2%); of which 63.5% were female and 36.5% were male. Most of the participants were in the age group of 19–24 years, i.e., 277 (90.2%) with a mean age of 19.43 years. There were 107 (34.9%) participants in 1st year, 104 (33.8%) participants in 3rd year and 96 (31.3%) participants in 2nd year [Table 1].
Table 1: Demographics variables of the participants

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The students participating in this study obtained a mean score of 60.1 ± 8.62. Majority of students shows good HPLP score, i.e., 245 (78.81%), 39 (12.70%) students had excellent HPLP score, 23 (7.49%) students had average HPLP score and no one had poor HPLP score [Figure 1].
Figure 1: Health Promotion Lifestyle Profile scorewise distribution of the participants

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As shown in [Table 2], the overall HPLP-II mean score was significantly more among the 1st- and 3rd-year students than 2nd year students. Among the health-promoting lifestyle subscales, health responsibility, physical activity, food practices, spiritual growth, self-concept, and stress management score was significantly lower in 2nd-year students than 1st year and 3rd year students (P < 0.05); but inter personal relations was same in all year.
Table 2: Comparison of overall Health Promotion Lifestyle Profile score, health responsibility, physical activity, food practices, spiritual growth, self-concept, inter personal relations, stress management Health Promotion Lifestyle Profile score according to years in study group

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As shown in [Table 3], there was no significant difference existed between the male and female students in the overall HPLP-II score (P > 0.05). Female students practiced significantly better food practices than male (P < 0.005), while male students practiced significantly better physical activity, self-concept (P < 0.0001, P < 0.05, respectively). Health responsibility, spiritual growth, inter-personal relation, and stress management score were more in female students than male students but not statistically significant (P > 0.05).
Table 3: Comparison of Health Promotion Lifestyle Profile score according to sex in study group

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The body mass index (BMI) for the participants revealed that 74.59% were in the normal range, 11.73% were underweight, 10.75% were overweight and 2.93% were obese. The mean BMI score of male students was 22.33 ± 10.49 and the female students were 21.95 ± 10.32; but no statistical significance was observed (t = 0.99; P = 0.32).

Focusing on the year of study in medical college, 71.96%, 71.88%, and 79.81% had a normal BMI, 13.8%, 13.54%, and 8.65% were underweight, 12.15%, 10.42%, and 9.62% were overweight and 2.80%, 4.17%, and 1.92% were obese, for 1st year students, 2nd-year students and 3rd-year students, respectively; but no significance was observed (P > 0.05).

No significant correlation was observed between the overall HPLP score as well as subscale score with BMI of the students.

As shown in [Table 4], there was no significant difference of overall HPLP score between the students living with family and those not living with family (P > 0.05). Food practice score was significantly higher with students living with family than the students not living with family (P = 0.001). Spiritual growth score was significantly higher with students not living with family than the students living with family (P = 0.002). Health responsibility, physical activity, self-concept, interpersonal relations, stress management score was the same with students living with family and students not living with family (P > 0.05).
Table 4: Comparison of Health Promotion Lifestyle Profile score according to living with family in study group

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There were no significant differences seen between students living with family and gender (χ2 = 1.64, P = 0.20), or between students living with family and year of study in medical college (χ2 = 0.11, P = 0.95).

A significant negative correlation was shown between income and overall HPLP score (−0.12, P = 0.037), physical activity (−0.12, P = 0.043), food practices (−0.13, P = 0.026), interpersonal relations (−0.14, P = 0.016), and no correlation between income and health responsibility, spiritual growth, self-concept, stress management (P > 0.05).

Multiple regression analysis of the six demographic variables with the overall HPLP score and seven health-promoting lifestyle subscales scores was performed to determine which independent variables were good predictors of a healthy lifestyle in the participants [Table 5]. With all six variables in the regression model, 2.4% (P > 0.05), 2.4% (P > 0.05), 8% (P < 0.0001), 7.4% (P = 0.001), 6.9% (P = 0.001), 1.9% (P > 0.05), 5.4% (P < 0.05) and 3.4% (P > 0.05) of the variance in the participants' overall HPLP score, health responsibility, physical activity, food practices, spiritual growth, self-concept, interpersonal relations, stress management, respectively, were explained by the model.
Table 5: Multiple regression analysis of independent baseline predictors of Health Promotion Lifestyle Profile score and demographic variables

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Several highly significant correlations were found for the independent variables, and a significant negative effect of income on the overall HPLP score was found. Significant negative effect for age on health responsibility; significant negative effect for sex and income on physical activity; significant effect for sex on food practices and significant negative effect for living with family, income on food practices; significant effect for sex, living with family on spiritual growth; significant effect for BMI on interpersonal relations and significant negative effect for income on interpersonal relations; and significant negative effect for age on stress management were found. No significant effect of demographic variables on self-concepts was found.


  Discussion Top


Health-promoting lifestyle is one factor that positively contributes to the quality of life. Life of the students in any college is a transitional period, offering good opportunities for establishing health-promoting lifestyles. Most research on health-promoting behaviors has been undertaken in the developed countries, where medical university students are little engaged in health-promoting behaviors, especially healthy diet, and physical activity.[7],[8],[9] There is a paucity of data on this issue. The HPLP score reflects the medical student's commitment of the health maintaining act, so better is the score, better will be the health profile of a student. The students participating in this study obtained a mean score of 60.1 ± 8.62; the majority of the students (78.81%) had good HPLP scores. This result was consistent with the results of various studies.[10],[11],[12] In the study evaluating the lifestyle and predicting changes in factors affecting the health status of a student performed by Babanejad et al. and a study from Nepal found that the lifestyle of most students was in the good level that is quite similar to the present study.[13],[14] The overall HPLP-II mean score was significantly more among the 1st- and 3rd-year students than 2nd-year students. Among the health-promoting lifestyle subscales, health responsibility, physical activity, food practices, spiritual growth, self-concept, and stress management score was significantly lower in 2nd-year students than 1st- year and 3rd-year students; but interpersonal relations was same in all year. The 1st-year medical student is faced with the challenges of being uprooted from family and friends and adapting to a demanding new learning environment, but in our study, they had a healthier lifestyle than the 2nd-year students. Contrary to expectations, the points of the first class students in the HPLPS tests, who expected to have less information about healthy living, was significantly higher in the responsibility of health, physical activity, moral development, and stress management sub-scales. On entry to medical school, students' lifestyle was satisfactory in terms of weight, stress levels, and perceived health. One year after their admission to medical school, their lifestyle had deteriorated considerably. Thus, most of the students could have led a sedentary lifestyle during their second year. They reported poorer health, increased stress, and consumption of fast foods and a reduction in exercise to counter stress. As they are mature students, this change cannot be explained by a move from sheltered home life. While reports on this sort of deterioration over the course of medical studies is not new, our findings indicate that greater efforts are needed to reduce the stress and burden of medical studies, provide a healthier medical school environment, and incorporate lifestyle medicine more effectively into the medical curriculum.[15] No significant difference existed between the male and female students in the overall HPLP-II score; however, the study which took place in India showed that females had higher points than males. Female students practiced significantly better food practices than male while male students showed a significantly higher level of physical activity and self-concept than female students. In many studies, male students scored better than female students in the physical activity subscale.[16],[17],[18] This might be due to behavioral and cultural factors. The female students were more conscious about their diet than their male counterparts. The study which was carried out by Wei et al. demonstrated that there is no significant differences of HPLP points between males and females. These results can be interpreted in that, according to the type of the study, the results may have shown differences between genders. In different cultures, different roles have been expected from different genders so it can differentially effect the perception of the importance of health between males and females.[17],[18] There was no significant difference of overall HPLP scores between the students living with family and those not living with family. Food practice score was significantly higher with students living with family. This might be because these students, who live with family have regular meals daily, eat breakfast regularly and they tend to eat healthier foods like fruits, vegetables, and grains, etc., The data suggest that students living with family have a better nutritional balance in their daily meals. Spiritual growth score was significantly higher with students not living with family than the students living with family. This was a somewhat controversial as in other studies they found more number of students among the living with family have a high spiritual score.[19],[20] This might be due to less number of students in this study were living with the family. India is culturally rich country where multiple religions co-exist and not only the older but young also engage in prayers and cultural rituals. A significant negative correlation was shown between income and overall HPLP score physical activity, food practices and inter-personal relations. The HPLP scores of students with poor economic status were lower. The results of various studies among university students supported this finding.[10],[11],[13],[15] Some studies observed no relationship between scores of the HPLPS and economic status.[4],[20] Some studies have established that socioeconomic level is associated with healthy practices[21] but within medical college life, this factor could be a double-edged sword; higher income may encourage the student to embrace the active social life of this particular environment, but it may also represent an easy way to gain access to the negative aspects of medical college life.[22] Social and economic factors should be handled together to evaluate behavior about health.

On multiple regression analysis, a significant negative effect of income on the overall HPLP score was found. The significant negative effect for age on health responsibility; significant negative effect for sex and income on physical activity; significant effect for sex on food practices and significant negative effect for living with family, income on food practices; significant effect for sex, living with family on spiritual growth; significant effect for BMI on interpersonal relations and significant negative effect for income on interpersonal relations; and significant negative effect for age on stress management were found. Practically, it is found that consciousness of health increases with age. Similar results were obtained in a study among medical students of Saudi University.[4] The reason we found such results with this study may be associated with the stress and responsibilities of the medical students with rising ages.[8] In this study, BMI was not without effects on the other aspects of health-promoting lifestyle behaviors; in fact, there was a significant negative association between BMI and interpersonal relationships. BMI as a determinant of a healthy lifestyle has been analyzed by other studies performed among nurses in Kuwait which highlighted the correlation between BMI and an overall health-promoting lifestyle and nutrition.[23] The students when promoted to a higher class the stress levels were also increasing which is characterized by a relatively stressful schedule that prevents students from practicing sports and eating a healthy diet in medical college life.

The response rate among this study was good. This study has some limitations. Students were enrolled from one medical college only; thus, the results cannot be generalized to the total population of medical students in the country or to students in other fields. For data collection, a self-reported questionnaire was used; thus, participants' responses may not always reflect reality. Further studies should be conducted in both similar and diverse settings at regular intervals to identify needs, use feasible interventions, and evaluate proceedings.


  Conclusions Top


Medical students of this Institute showed a good level of health-promoting lifestyle in total HPLP II score. The overall HPLP-II mean score and all subscales of HPLP except interpersonal relations were significantly more among the 1st- and 3rd-year students than 2nd-year students. Female students practiced significantly better food practices while Male students showed a significantly higher level of physical activity and self-concept. Income was the significant predictor of overall HPLP; age was the significant predictor of Health responsibility, sex, and income were the significant predictor of physical activity, sex, living with family and income were a significant predictor for food practices; sex, living with the family were predictors of spiritual growth; BMI and income as a predictors for Interpersonal relations; and age as was a predictor for stress management. Study findings suggest the importance of planning and prioritizing health-promoting activities for medical students to not only improve their lifestyles and health but also to possibly support population health-promoting programs. Health education sessions should be conducted regularly and students should be motivated to adopt healthy lifestyle practices.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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